Detection of human papilloma virus (HPV) in oral mucosa of women with cervical lesions and their relation to oral sex practices. Should we start testing partners?

Source: 7thspace.com
Authors: Luis Sanchez-Vargas et al

Previous studies have either investigated the relationship of HPV with oral cancer or the prevalence of HPV on the oral cavity. The purpose of this investigation was to study the prevalence of HPV in oral cavity of women with oral sex practices and cervical lesions.
Methods:

Forty six (46) non-smokers and non-alcoholic patients attended the “Clinica de Displasias”of “Ciudad Juarez”were sampled. This population had a CIN (cervical intraepithelial neoplasia) diagnosis sometime between the previous six months. On previous consent they filled out a questionnaire related to their oral sex practices. Afterwards one swab from cheeks and another from palate/gum were taken; PCR (polymerase chain reaction) was used to determine generic HPV, HPV16 and HPV18.
Results:

Seventy two percent (72%) of the patients stated to have oral sex practices regularly which all of them were positive to HPV either in oral mucus, palate/gum or both. The total of the given results showed that 35% had HPV16; among those distributed in 26% with regular oral sex practices and 9% stated as never practiced oral sex.
An association was found between oral HPV16 positivity and progression to CIN advanced lesions. On the other hand HPV18 was not detected. The frequency of HPV16 was higher in buccal mucosa (23%) versus palate/gum (16%).
Conclusions:

This study suggests that buccal HPV16 infection is associated with CIN progression.
Source: Infectious Agents and Cancer 2010, 5:25
Authors: Luis Sanchez-Vargas, Cecilia Diaz-Hernandez, Alejandro Martinez-Martinez

Is HPV a cause or a coincidental finding with oral cancer and how can you test for HPV in the mouth?

We find papers and opinions supporting both positions on this controversial subject. It is a widely held belief that HPV is a risk factor at some level with oral cancer; however, there is not clear scientific evidence of the exact connection between the HPV virus and oral cancer. However, most opinions conclude that HPV can cause dysplasia.

So is there an HPV test for saliva that will diagnose the presence of the HPV virus in the mouth?

Yes. It is a DNA -PCR type test which is also used to collaborate abnormal Pap smear results as well as the Capture II tests. The real question is if the HPV test is accurate and is it a true screening exam for HPV’s we see in oral cancer?

Although the DNA-PCR tests in general have proved valuable in medicine, we are waiting and hopeful to see independent results. A proven tool such as this screening test can be helpful to determine which patients are at higher risk while their HPV is active.

HPV Activity or Dormancy in the HPV Test

Now there is the subject of HPV activity or dormancy. We know the viruses are very prevalent in our society and they have periods of activity when they can be detected. It is a commonly held belief the virus can be present but dormant, HPV can also be eliminated. There is an immune component that can effect the virus activity. So timing is an issue, begging the question when do you test? You can be positive and then be negative. How you manage that information with the patient is still being debated.

So is there an HPV test for the mouth? Yes.

Accurate? Most likely, not independently verified as of yet.

Helpful? Depending upon how it is used.

Accurate predictor of susceptibility to oral cancer? Very hard to quantify at this point.

If accurate, and HPV detected in identified susceptible individuals what will you do with this information? Do a more through oral cancer examination, closer recalls, tonsillectomies or use light source screening devices.  All can be viable options.

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Our goal as an oral cancer awareness organization is to present unbiased information. In tandem, we desire to provide awareness and only offer conclusive evidence by disseminating information from independent and qualified sources. That is our goal.

Like most it is information that you as the doctor use in your best judgment because you are the best to decide what is best for your patients.

Baylor College of Dentistry is active in the fight against oral cancer.  They are actively researching the disease in order to have success in fighting it.  In order to be successful, they need saliva samples from those that have been diagnosed with oral cancer.  Baylor especially needs samples from patients that have not yet begun treatment. It takes less than 30 minutes and they will pay you or your favorite charity for your saliva donation.

For more information, please view Baylor flyer.

If you can participate in this important study, please contact:

Lee Jordan, Department of Diagnostic Sciences,
TAMHSC-Baylor College of Dentistry,
(214) 370-7213
Jordan@bcd.tamhsc.edu

The National Institute of Dental and Craniofacial Research (NIDCR) reported recently that African Americans are at the highest risk for contracting oral cancer. In an effort to raise awareness and provide helpful information regarding risk factors, they have put together the below informative video. Please watch and feel free to offer any comments you might have.

Recently, Science Daily posted an article with updates on advancements in oral cancer research.  According to the article, early detection could save upwards of 40,000 people daily.  Below is an excerpt of this groundbreaking news:

“Case Western Reserve University School of Dental Medicine researchers discovered a biomarker, called human beta defensin-3 (hBD-3), which may serve as an early warning. The defensin is present in all oral cancers and associated with the early stages of oral cancer.

‘Using the biomarker to detect oral cancer holds potential for saving lives when the cancer is most curable. Annually some 10,000 people die from this cancer,’ said Ge Jin, assistant professor of biological sciences at the dental school.

He led the study, which appears in the online journal PLoS ONE, published by the Public Library of Science.

Oral cancer first appears as white or red lesions in the mouth, the same as noncancerous lesions.

Often, the lesions are not biopsied, and cancer is not discovered until it becomes apparent in its later stages, when it has metastasized to other organs. Such a late-stage diagnosis is generally fatal and can result in costly surgeries and treatments or disfigurement that may include removing parts of the tongue, jaw and cheek. All this can be avoided with early removal of the lesion.”

Click here for the complete Science Daily article regarding the role of hBDs in oral health and the potential of using this biomarker to detect oral cancer early.

When you or a loved one is diagnosed with any form of cancer, the question of survival rate often comes up.  A survival rate is something that is not absolute, but is mainly a gathering of statistics based on the results of past patients with the same types and progression of cancer upon diagnosis.  According to the Mayo Clinic, “Cancer survival rates or survival statistics tell you the percentage of people who survive a certain type of cancer for a specific amount of time.”  The survival rate uses a 5-year scope, meaning that after 5-years it will tell you the percentage of patients that are living.

According to the National Institute of Dental and Craniofacial Research, “60% of those with oral cancer survive over 5 years.”  Since 1965 the survival rate has been increasing, due to more awareness and earlier detection.  Below is a table that was provided by NIDCR regarding trends in survival based on race, gender, and race.

Ever since we began The Fight Oral Cancer Foundation in 2008 with the slogan “Be a Life Saver”, we’ve been dedicated to giving towards the cause of fighting oral cancer.

Every dollar counts when it comes to saving a life.

Your donations* will go toward:

1. Educational pamphlet to be distributed at schools, hospitals, health fairs and public libraries locally and nationwide.
2. Provide dental care and dental hygiene educational programs for children.
3. Hold free oral cancer screenings locally and nationwide.
4. Sponsor speakers to raise awareness and promote screening.
5. Fund oral cancer research.

*95% of all donations go toward the foundation’s cause and only 5% is used to cover administrative expenses.

Join others as together we fight oral cancer.  Click here to donate.

Together we fight oral cancer. Together we save a life every hour.

There are many technologies that boast of the ability to detect pre-cancer conditions for oral cancer.  These oral cancer screening technologies look for abnormal cells that when detected will allow the physician to be able to more precisely locate risk areas and do a more thorough assessment.  However, the question arises: “Do these technologies truly live up to their claims?”

The research in the article Oral Precancer and Early Cancer Detection- A Review of Technologies by Jerry E. Bouquot, DDS, MSD, Patricia Suarez, DDS, MS and Nadarajah Vigneswaran, BDS, DMD3 provides an overview and summary of the technologies that are out there, determining if they are what they claim to be.

In reviewing oral cancer screening, the procedures that are covered are:

• The Brush Biopsy
• Toluidine Blue – in Vivo Staining of DnA in the Dental Office
• The ViziLite – Highlighting the Keratin
• Oral Autofluorescence – When the Mucosa doesn’t glow

In conclusion on their oral cancer screening technology review they had this to say:

“Our intention is not to recommend one of these technologies over another, but the future looks most bright for the optical autofluorescence technology (pardon our pun), combined with either a biopsy, brush biopsy or LBC. All devices have limitations and the published research is sparse, but until other methods are developed, such as the use of molecular markers in salivary proteomics or genomics, it is heartening to know that relatively acceptable in-office devices are already available and can be used as adjunctive diagnostic tools. Refinements and continued research will undoubtedly improve our ability to detect, at the earliest possible stage, dysplastic changes in our patients, and new technologies may emerge quickly which will prove much more valuable. Until then, it is refreshing to be practicing dentistry during a time of such exciting emerging technologies attempting to address one of the most frustrating and serious of our oral diagnostic dilemmas.”

Click here for the complete article on oral cancer screenings technologies.

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Photo Credit: Oral Cancer

Recently Science Daily posted an article entitled: SIBLING Proteins May Predict Oral Cancer. This article is interesting as it offers greater hope in the advancement of oral cancer treatment.  A SIBLING stands for Small Integrin-Binding Ligand N-linked Glycoproteins.

“Several years ago we discovered that three SIBLINGs — osteopontin, bone sialoprotein and dentin sialophosphoprotein — were expressed at significantly high levels in oral cancers,” said Dr. Kalu Ogbureke, an oral and maxillofacial pathologist in the MCG School of Dentistry. “Following that discovery, we began to research the potential role of SIBLINGs in oral lesions before they become invasive cancers.”

Up to this point it’s been so difficult to determine which cells were precancerous that early oral cancer treatment has been difficult.  With the research on SIBLING proteins, there is hope for better results for treatment.

Dr. Ogbureke’s next step is to design a multi-center study that incorporates oral cancer risk factors, such as smoking and alcohol consumption, to further investigate their relationship with SIBLING protein expression.

A risk simply means that there is an increased risk to a disease, but does not mean that it is a cause of a disease.  For instance, if a substance produces a weakening in the body’s natural ability to fight disease, than it would be termed a risk factor.  Mouthwash has been promoted for years as a way to improve the health of the mouth. However, with the high amounts of alcohol in many mouthwashes, there has been substantive evidence that has raised the concerns of researchers regarding the safety of mouthwash.  There have been studies that have shown that mouthwash could increase the chances of oral cancer.

The ethanol in mouthwash is thought to allow cancer-causing substances to permeate the lining of the mouth more easily and cause harm.

Acetaldehyde, a toxic by-product of alcohol that may accumulate in the oral cavity when swished around the mouth, is also believed to be carcinogenic.

Some mouthwash contains as much as 26 percent alcohol.

The University of Maryland reveals,

Some studies have shown that mouthwash with alcohol content increases the risk for oral cancer. In addition, other studies have shown that smokers and people who drink alcohol tend to use mouthwash more often, linking all three factors together.

The American Cancer Society mentions the concerns toward mouthwash being a risk factor for oral cancer. However, they state that the concerns are uncertain, unproven and controversial, albeit worthy of mention.

Some studies have suggested that mouthwash with high alcohol content might be linked to a higher risk of oral and oropharyngeal cancers. But recent research has questioned these results. Studying this possible link is complicated by the fact that smokers and frequent drinkers (who are already at increased risk of these cancers) are more likely to use mouthwash than people who neither smoke nor drink.

Whether or not mouthwash is a cause of oral cancer, is certainly being debated as there are controversial opinions on the matter. However, if a risk factor means that the guards that could protect a patient from acquiring oral cancer are reduced than the risks for oral cancer are certainly in question.  The Australian Dental Association has the question on their radar as well.  They sum up the controversy nicely with the below:

“The most significant difference (between alcohol and alcohol-containing mouthwash) is that one is for pleasure and the other is being recommended as a health product.”

Cancer Council NSW chief executive Andrew Penman said the review was “interesting”, but called for further research.

“I think it’s quite a well-thought-out proposition, but it does warrant further investigation,” he said.

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Photo Credit: Telegraph